Child and adolescent mental health services (Camhs) lack leadership and effective joint working, are driven by short-term funding and fail to meet the needs of vulnerable children, according to an interim report.
The interim report of a review of Camhs commissioned by the Department of Health and Department for Children, Schools and Families also criticised both departments.
The review, headed by Gloucestershire Council director of children’s services Jo Davidson, found that, unlike areas such as child safeguarding, accountability and leadership in Camhs was “diffuse”.
It said: “It is not clear, for example, who has the accountability for ensuring that every child has access to the right intervention at the right time to address psychological or mental health issues.”
Clarity needed on DH/DCSF responsibilities
The report said the respective responsibilities of the DH and DCSF, who lead jointly on Camhs policy, needed clarifying, while there was varying practice among regional strategic health authorities in the priority given to Camhs, with some “paying little attention to the development of specialist care”.
Accountability needed to be tightened at a between councils and primary care trusts, while it said that joint commissioning was underdeveloped. But it reported a “perception” that the DH and DCSF’s approaches to supporting commissioning were “insufficiently joined-up”.
The review found the current dependence on short-term funding led to difficulties in long-term planning, the viability of good programmes and workforce stability. It said councils and PCTs needed to do more to align budgets but said government could needed to “underline its commitment to the long-term nature of funding”.
Unmet need for vulnerable children
The review said it was “concerning” that there was continuing evidence of “unmet need and interagency wrangling” regarding responsibility for vulnerable children, such as those with learning disabilities or in the care system.
It said “too often” the staff with the least experience of mental health issues – such as residential social workers, teaching assistants, youth justice staff and newly-qualified practitioners – spent most time with the most vulnerable children. Although it said these staff could make a difference if properly supported.
It called for increased focus on mental health training across the children’s workforce. The review found that school, college and early years staff were now carrying out work which in the past would have been undertaken by specialist health and social care staff but that supervision arrangements in these services were underdeveloped.
Criticism of performance indicators
It said current performance indicators for Camhs were focused too much on processes not outcomes. Current indicators cover providing age-appropriate services for 16- and 17-year-olds, a service for children with learning disabilities and 24-hour emergency care, and joint commissioning of early intervention support.
Despite the criticisms, Davidson said there was “a lot of excellent work going on in all areas of Camhs”, adding: “All services need to adopt the approaches used by the best services.”
The review’s final report will be published this autumn.